Rep. Bart Stupak D- Mich and Sen. Ben Nelson D-Neb, helped offer compromises on the bill to win Republican support.

IHCIA Passes Despite GOP Abortion Controversy

Rob Capriccioso
1/7/11

WASHINGTON – Republican abortion-based opposition to the Indian Health Care Improvement Act as part of the nation’s health care reform package couldn’t stop the bill from clearing Congress.

The Indian-focused legislation passed the Senate early on Christmas Eve. It had already passed the House Nov. 7 as part of its broad-based health care reform package.

The reform deal, including the Indian health provisions, is now set to go before conference committee in both chambers to iron out differences.

Once that process occurs, President Barack Obama is expected to sign the whole legislation into law. It is widely known that he’d like to do so by his State of the Union address in late-January, but some political observers believe the timeframe is too optimistic, given substantial difference in the House and Senate versions of the legislation.

Despite the differences in the larger bill, the Indian health sections are similar.

The Indian sections of the legislation are notable because they would permanently reauthorize the IHCIA if signed into law. Indian advocates have been fighting for permanent reauthorization for years.

While politicians from both parties agree the legislation is crucial to improving the health and welfare of many Native Americans, some Republicans tried to stop passage of the IHCIA as part of the national health care reform by creating a last-minute controversy surrounding abortion provisions in the Indian sections.

The issue of abortion – and how it would be funded in the national health care reform deal – threatened many times over the past months to derail the entire health care bill.

To get over the hurdle, the House ended up agreeing to an amendment offered by Rep. Bart Stupak, D-Mich., which would ban plans in insurance exchanges created by the legislation from covering abortions.

The Senate, meanwhile, ultimately agreed to a late compromise hammered out to garner the support of Sen. Ben Nelson, D-Neb., which gives states the choice to ban abortion coverage in insurance exchanges the legislation creates.

But after that Senate compromise was struck with Nelson, some Republicans implied that the Indian health provisions weren’t covered under the deal.

The weekend before the Senate reform passed with 60 votes – none of them Republican – GOP legislative aides worked overtime to prevent the bill’s passage by using the IHCIA as a wedge.

Some Republican aides told the influential Roll Call newspaper, read largely by an inside-the-Beltway audience, including members of Congress, the Indian health provisions were at odds with the mission of pro-lifers.

Roll Call explained in an article published Dec. 19 that Democrats included “by reference” legislation passed by the Senate Committee on Indian Affairs last year covering health care in Indian country.

Republicans argued anonymously in the article that the action ended up not including abortion provisions prohibiting the federal government from funding abortions.

“When you drop major pieces of legislation into a 2,000-page bill simply by reference, you’re going to make mistakes. For advocates of life, this mistake is a huge one,” a GOP aide told the paper.

The goal seemed to be to derail the entire health care legislation by saying that IHCIA was abortion-friendly.

For some Indian health advocates, it was an eerie reminder of 2008, when a similar issue over abortion prevented the IHCIA from passing Congress after Sen. David Vitter, R-La., inserted strict anti-abortion provisions during floor debate.

The bill could not pass muster in the House given the Vitter language.

Democrats this year were quick to prevent a similar GOP tactic, however. They ended up including language in the health care legislation affirming that IHCIA provisions will be in compliance with the rest of the bill on abortion issues.

After the abortion dilemma played out, some Native American health experts said the issue was somewhat of a smokescreen. They noted that there has been a federal ban on abortion funding since 1977 under the Hyde Amendment, and it requires IHS to comply with that ban.

Jim Roberts, a policy analyst with the Northwest Portland Area Indian Health Board, said IHS funding cannot be used for abortions and added that the Nelson agreement doesn’t change policy substantively for IHS on the matter.

Tom Rodgers, a tribal affairs lobbyist with Carlyle Consulting, said having the IHCIA as part of the larger health care reform deal helped provide a cover for the Indian health provisions regarding the contentious abortion issue.

“It felt like déjà vu all over again,” Rodgers said. “But this time it didn’t take us down.”

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